Individual
SURESH MANAPURAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
2620 W FAIDLEY AVE, DEPT OF HOSPITAL MEDICINE, GRAND ISLAND, NE 68803
(412) 713-2191
Mailing address
2620 W FAIDLEY AVE, DEPT OF HOSPITAL MEDICINE, GRAND ISLAND, NE 68803
(412) 713-2191
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
30750
NE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30750
NEBRASKA MEDICAL LICENSE NUMBER
NE
Enumeration date
06/17/2014
Last updated
06/05/2018
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